Development of malignancy following living donor kidney transplantation

Malignancy following renal transplantation is an important medical problem during the long-term follow-up. We studied some features of the cancers that developed in our patients.

We retrospectively reviewed all patients who underwent renal transplantation and developed malignancy from July 1984 to July 2004.

The 2117 patients who underwent living donor kidney transplantation during the 19-year period had a mean follow-up of 81.1 +/- 61 months. During the follow-up, 38 patients (1.8%) developed cancer: 14 Kaposi's sarcomas, 11 lymphoproliferative diseases, four squamous cell carcinomas of the skin, two basal cell carcinomas, one breast, one ovary, one melanoma, one seminoma, one lung, and one ovary. Mean age at transplantation in the malignancy cases was higher than the other recipients (43.5 +/- 12.1 vs 32 +/- 13.9 years) (P = .000). A Kaposi's sarcoma occurred earlier compared with the other cancers (23 +/- 22 vs 62 +/- 44 months P < .05); most of these patients were over 40 years at transplantation (P < .05). We also observed that patients treated with mycophenolate mofetil developed cancer earlier than the others (19 vs 52 months; P = .001). None of the cases with lymphoma had a history of antilymphocytic agent therapy. The 10-year patient survival was 73%.

The prevalence of cancer (1.8%) was among the lowest compared with other studies possibly due to implementing a living donor kidney transplantation program that required a low frequency of induction therapy.